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Tyranny of the Healthy

How ObamaCare will sacrifice the elderly and chronically ill.

As he begins his commentary in the New York Times, a former Obama administration official offers a breathtaking suggestion for American health care.

"We need death panels."

Having arrested his readers' attention, Steven Rattner explains.

"Well, not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget."

Rattner, a former Treasury Department counselor who helped design the $82 billion bailout of General Motors and Chrysler, has extensive experience on Wall Street and in journalism -- but none in medical practice or administration.

Nevertheless, Rattner offers an example for American health care to follow.

"Take Britain, which provides universal coverage with spending at proportionately almost half of American levels," Rattner writes. "Its National Institute for Health and Clinical Excellence uses a complex quality-adjusted life year system to put an explicit value (up to about $48,000 per year) on a treatment’s ability to extend life."

Britain's National Health Service (NHS), the single-payer model Rattner endorses, routinely sacrifices the elderly and the seriously ill on the altar of cost containment.

British newspapers constantly expose the NHS. In June, the Daily Mail reported that about 130,000 elderly patients -- many of whom could be saved -- die every year after doctors arbitrarily impose a treatment protocol for the terminally ill. That protocol, the Liverpool Care Pathway, allows doctors to replace water and intravenous feeding with automatic morphine injections that cause death in an average of 33 hours.

"Patients are frequently put on the pathway without a proper analysis of their condition," said Dr. Patrick Pullicino, a consulting neurologist and professor of clinical neurosciences at the University of Kent.

"Very likely, many elderly patients who could live substantially longer are being killed by the LCP," Pullicino told the Royal Society of Medicine. "If we accept the Liverpool Care Pathway, we accept that euthanasia is part of the standard way of dying as it is now associated with 29 per cent of NHS deaths."

The article elicited 462 comments on the Daily Mail's Web site.

"I have a very good understanding of the L.C.P," writes Alyson White from Yorkshire. "My Nan was still able to eat and drink small amounts, until a Syringe Driver was placed in her arm. She never woke again after that....My Nan was not terminally ill, the L.C.P. is misused and sadly so many thousands of vulnerable people are dying prematurely and unnaturally."

Bea from Manchester saw the LCP applied to "a relative who simply suffered a small stroke and was fully alert, able to converse and move her right side of her body," she writes. "... we witnessed all food and fluids removed, morphine in large amounts introduced and the family left to watch her die, not in 33 hours, but over a week of suffering.

"If I did that to my dog I would be reported and taken to Court."

Both the Daily Mail and the Guardian also reported in June that 90 percent of NHS hospitals limit the number of surgeries their doctors perform to save money -- including hip and knee replacements, and cataract removal. Both newspapers cited reports from GP Magazine, a periodical for British doctors, and the Labour Party.

With waiting lists for surgeries routine in Britain, the policy "means patients face joining a waiting list to even get on the surgery waiting list," wrote the Daily Mail's Claire Bates.

Andy Burnham, the secretary of state for health in Labour's shadow cabinet, said the Labour Party is "presenting new evidence of crude, random rationing across the NHS in England, going far wider and deeper than ... suggested."

Such restrictions affect not only the elderly, as Linda from Scotland wrote on the Daily Mail's site (lack of punctuation in original):

"I Am in my 30s have a young family to look after in constant pain for over a year suspected slipped discs denied MRI and surgery even though i can barely walk or work and told all they can do is send me on my way with codeine and other addictive drugs . I am struggling to keep my life together not easy when i can barely lift my baby son. thanks Nhs for nothing."

Not only does the NHS effectively prohibit many surgeries. In 2005, the Telegraph reported that NHS consultants refuse to recommend new cancer treatments and drugs -- though they have passed clinical trials, can save lives and could be purchased privately.

Why? Because Britain’s National Institute for Health and Clinical Excellence -- which Rattner praises -- had yet to review them.

"We have been begging the health service to make the latest cancer drugs available," said Dr. Harpreet Wasan, an oncologist at London's Hammersmith Hospital. "They allow patients to survive longer and it seems unfair they are not available. These drugs are superior to existing drugs and patients should have access to them."

NHS even limits traditional cancer treatments. The Telegraph again reported in June that women older than 65 are less likely to receive chemotherapy or radiation therapy, and are more likely to die from breast cancer. Women older than 70 are less likely to have breast tumors surgically removed.

In the same article, the Telegraph reported that a 2009 study by the King's Fund, a charitable health foundation, revealed these findings:

-- Elderly patients waited longer in emergency rooms, went to intensive care less often and underwent surgery after a traumatic injury less often.

-- Elderly patients who suffered heart attacks and strokes received fewer examinations and less treatment.

As a result, victims of cancer and cardiac arrest are far more likely to die in Britain than in almost any other developed nation.

According to the Organization for Economic Cooperation and Development's 2009 survey on health-care standards, a British woman stands a 78.5 percent chance of surviving breast cancer after five years; the percentage for an American woman was 90.5, best in the group. A British victim of bowel cancer has just a 51.6 percent chance of surviving after five years compared to 65.5 percent in the United States -- again, best in the category.

Finally, 6.3 percent of Britons who have heart attacks will die within 30 minutes of admission to a hospital. Only South Korea, Luxembourg and the Netherlands have worse rates.

Sir William Wells, a former NHS regional director, diagnosed the fundamental problem: “The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture.”

Yet even the Church of England supports NHS at the expense of the vulnerable. Bishop Tom Butler, vice-chairman of the church's Mission and Public Affairs Council, said in 2006 that letting severely ill or disabled newborns die would be more compassionate -- and less expensive.

"The principle of justice," Butler wrote, "inevitably means that the potential cost of treatment itself, the longer term costs of health care and education and opportunity cost to the NHS in terms of saving other lives have to be considered.”

Compare the bishop's remarks to Rattner's belief that "elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical."

Compare them to those made at the NHS's 60th anniversary in 2008 by Dr. Donald Berwick, former administrator for the Centers for Medicare and Medicaid Services who resigned in December.

"I am romantic about the NHS; I love it," said Berwick, who added he "cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do."

Compare them to the current president's views. While running for the Senate in 2003, Obama told the Illinois AFL-CIO:

"I happen to be a proponent of a single payer universal health care program....But as all of you know, we may not get there immediately...."

"...I don't think we're going to be able to eliminate employer coverage immediately. There's going to be potentially some transition process. I can envision a decade out or 15 years out or 20 years out where we've got a much more portable system....And I think we've got to facilitate that and let individuals make that choice to transition out of employer coverage." (emphases added)

But as the NHS illustrates, universal coverage through a government monopoly is a lie. What good is such "coverage" when patients' legitimate needs constitute threats to state accountants and bureaucrats?

In the zeal to expand coverage, do we want patients and their families to have as many choices as possible in deciding how to manage their own care? Or do we allow Berwick's "leaders" to make those decisions for us -- and, ultimately, decide who lives and who dies?